14132.235.
(a) For Denti-Cal and dental managed care plan beneficiaries with special dental care needs, the department shall provide coverage for both of the following additional services necessary to provide dental services as a covered benefit in the Denti-Cal program: a payment adjustment to providers.(1)Behavior management.
(2)Dental case management.
(b) The department shall establish reimbursement rates for the services the payment adjustment identified in subdivision (a) when billed in addition to the provision of other dental services for a Denti-Cal beneficiary or dental managed care plan enrollee with special dental service needs, to compensate for the additional time and resources required to arrange for, provide for, and follow-up on dental treatment for, these individuals.
(c) Dental
providers shall document in the patient’s medical record the need for the additional services provided pursuant to this section.
(d) As used in this section, the following terms have the following meanings:
(1)“Behavior management” means the additional time, resources, or techniques required to perform dental procedures for an individual with special dental service needs,
(2)“Dental case management” means the time and effort spent for an individual with special dental service needs in addressing appointment compliance barriers, assisting the individual to attend scheduled appointments by solving transportation challenges or other barriers, and obtaining consent and medical consultation
or clearance to perform dental procedures.
(3)
(1) “Denti-Cal or dental managed care plan beneficiary with special dental care needs” means a Denti-Cal or dental managed care plan beneficiary with chronic medical, physical, mental, behavioral, or developmental conditions or other disabilities that complicate his or her dental care or require the dental provider to provide additional expertise, actions, and resources.
(2) “Payment adjustment” means the additional reimbursement provided to Denti-Cal and dental managed care plan providers treating patients with special dental care needs. This payment is an adjustment to compensate for the extra time and resources needed to complete the care needed for Denti-Cal and dental managed care plan beneficiaries with special dental care needs that would not otherwise have been expended on healthier Denti-Cal and dental managed care plan beneficiaries.
(e) This section does not limit the provision of of, or scope of
of, Denti-Cal or dental managed care plan services covered under existing law.
(f) The department shall seek any necessary approvals from the federal Centers for Medicare and Medicaid Services to implement this section. The department shall implement this section only in a manner that is consistent with federal Medicaid law and regulations, and only to the extent that the necessary approvals are obtained and federal financial participation is not jeopardized.
(f)
(g) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement, interpret, or make specific this section, and any applicable federal waivers and state plan amendments, by means of all-county letters, plan letters, plan or provider bulletins, or similar instructions, without taking regulatory action. By July 1, 2022, the department shall adopt regulations in accordance with the requirements of Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code. Commencing January 1, 2020, the department shall provide a status report to the Legislature on a semiannual basis, in compliance with Section 9795 of the Government Code, until regulations have been adopted.